Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report

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dc.contributor.authorStein, Dan J.
dc.contributor.authorKazdin, Alan E.
dc.contributor.authorRuscio, Ayelet M.
dc.contributor.authorChiu, Wai T.
dc.contributor.authorSampson, Nancy A.
dc.contributor.authorZiobrowski, Hannah N.
dc.contributor.authorAguilar-Gaxiola, Sergio
dc.contributor.authorAl-Hamzawi, Ali
dc.contributor.authorAlonso, Jordi
dc.contributor.authorAltwaijri, Yasmin
dc.contributor.authorBruffaerts, Ronny
dc.contributor.authorBunting, Brendan
dc.contributor.authorde Girolamo, Giovanni
dc.contributor.authorde Jonge, Peter
dc.contributor.authorDegenhardt, Louisa
dc.contributor.authorGureje, Oye
dc.contributor.authorHaro, Josep M.
dc.contributor.authorHarris, Meredith G.
dc.contributor.authorKaram, Aimee
dc.contributor.authorKaram, Elie G.
dc.contributor.authorKovess-Masfety, Viviane
dc.contributor.authorLee, Sing
dc.contributor.authorMedina-Mora, Maria E.
dc.contributor.authorMoskalewicz, Jacek
dc.contributor.authorNavarro-Mateu, Fernando
dc.contributor.authorNishi, Daisuke
dc.contributor.authorPosada-Villa, José
dc.contributor.authorScott, Kate M.
dc.contributor.authorViana, Maria C.
dc.contributor.authorVigo, Daniel V.
dc.contributor.authorXavier, Miguel
dc.contributor.authorZarkov, Zahari
dc.contributor.authorKessler, Ronald C.
dc.date.accessioned2021-10-07T10:33:52Z
dc.date.available2021-10-07T10:33:52Z
dc.date.issued2021-08-09
dc.date.updated2021-08-15T03:32:11Z
dc.description.abstractBackground Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the prevalence and predictors of patient-reported treatment helpfulness for DSM-5 GAD and its two main treatment pathways: encounter-level treatment helpfulness and persistence in help-seeking after prior unhelpful treatment. Methods Data came from community epidemiologic surveys in 23 countries in the WHO World Mental Health surveys. DSM-5 GAD was assessed with the fully structured WHO Composite International Diagnostic Interview Version 3.0. Respondents with a history of GAD were asked whether they ever received treatment and, if so, whether they ever considered this treatment helpful. Number of professionals seen before obtaining helpful treatment was also assessed. Parallel survival models estimated probability and predictors of a given treatment being perceived as helpful and of persisting in help-seeking after prior unhelpful treatment. Results The overall prevalence rate of GAD was 4.5%, with lower prevalence in low/middle-income countries (2.8%) than high-income countries (5.3%); 34.6% of respondents with lifetime GAD reported ever obtaining treatment for their GAD, with lower proportions in low/middle-income countries (19.2%) than high-income countries (38.4%); 3) 70% of those who received treatment perceived the treatment to be helpful, with prevalence comparable in low/middle-income countries and high-income countries. Survival analysis suggested that virtually all patients would have obtained helpful treatment if they had persisted in help-seeking with up to 10 professionals. However, we estimated that only 29.7% of patients would have persisted that long. Obtaining helpful treatment at the person-level was associated with treatment type, comorbid panic/agoraphobia, and childhood adversities, but most of these predictors were important because they predicted persistence rather than encounter-level treatment helpfulness. Conclusions The majority of individuals with GAD do not receive treatment. Most of those who receive treatment regard it as helpful, but receiving helpful treatment typically requires persistence in help-seeking. Future research should focus on ensuring that helpfulness is included as part of the evaluation. Clinicians need to emphasize the importance of persistence to patients beginning treatment.en_US
dc.identifier.apacitationStein, Dan J., Kazdin, Alan E., Ruscio, Ayelet M., Chiu, Wai T., Sampson, Nancy A., Ziobrowski, Hannah N., ... Kessler, Ronald C. (2021). Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report. <i>BMC Psychiatry</i>, 21(Article number: 392), http://hdl.handle.net/11427/34194en_ZA
dc.identifier.chicagocitationStein, Dan J., Alan E. Kazdin, Ayelet M. Ruscio, Wai T. Chiu, Nancy A. Sampson, Hannah N. Ziobrowski, Sergio Aguilar-Gaxiola, et al "Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report." <i>BMC Psychiatry</i> 21, Article number: 392. (2021) http://hdl.handle.net/11427/34194en_ZA
dc.identifier.citationStein, Dan J., Kazdin, Alan E., Ruscio, Ayelet M., Chiu, Wai T., Sampson, Nancy A., Ziobrowski, Hannah N., Aguilar-Gaxiola, S. & Al-Hamzawi, A. et al. 2021. Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report. <i>BMC Psychiatry.</i> 21(Article number: 392) http://hdl.handle.net/11427/34194en_ZA
dc.identifier.ris TY - Journal Article AU - Stein, Dan J. AU - Kazdin, Alan E. AU - Ruscio, Ayelet M. AU - Chiu, Wai T. AU - Sampson, Nancy A. AU - Ziobrowski, Hannah N. AU - Aguilar-Gaxiola, Sergio AU - Al-Hamzawi, Ali AU - Alonso, Jordi AU - Altwaijri, Yasmin AU - Bruffaerts, Ronny AU - Bunting, Brendan AU - de Girolamo, Giovanni AU - de Jonge, Peter AU - Degenhardt, Louisa AU - Gureje, Oye AU - Haro, Josep M. AU - Harris, Meredith G. AU - Karam, Aimee AU - Karam, Elie G. AU - Kovess-Masfety, Viviane AU - Lee, Sing AU - Medina-Mora, Maria E. AU - Moskalewicz, Jacek AU - Navarro-Mateu, Fernando AU - Nishi, Daisuke AU - Posada-Villa, José AU - Scott, Kate M. AU - Viana, Maria C. AU - Vigo, Daniel V. AU - Xavier, Miguel AU - Zarkov, Zahari AU - Kessler, Ronald C. AB - Background Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the prevalence and predictors of patient-reported treatment helpfulness for DSM-5 GAD and its two main treatment pathways: encounter-level treatment helpfulness and persistence in help-seeking after prior unhelpful treatment. Methods Data came from community epidemiologic surveys in 23 countries in the WHO World Mental Health surveys. DSM-5 GAD was assessed with the fully structured WHO Composite International Diagnostic Interview Version 3.0. Respondents with a history of GAD were asked whether they ever received treatment and, if so, whether they ever considered this treatment helpful. Number of professionals seen before obtaining helpful treatment was also assessed. Parallel survival models estimated probability and predictors of a given treatment being perceived as helpful and of persisting in help-seeking after prior unhelpful treatment. Results The overall prevalence rate of GAD was 4.5%, with lower prevalence in low/middle-income countries (2.8%) than high-income countries (5.3%); 34.6% of respondents with lifetime GAD reported ever obtaining treatment for their GAD, with lower proportions in low/middle-income countries (19.2%) than high-income countries (38.4%); 3) 70% of those who received treatment perceived the treatment to be helpful, with prevalence comparable in low/middle-income countries and high-income countries. Survival analysis suggested that virtually all patients would have obtained helpful treatment if they had persisted in help-seeking with up to 10 professionals. However, we estimated that only 29.7% of patients would have persisted that long. Obtaining helpful treatment at the person-level was associated with treatment type, comorbid panic/agoraphobia, and childhood adversities, but most of these predictors were important because they predicted persistence rather than encounter-level treatment helpfulness. Conclusions The majority of individuals with GAD do not receive treatment. Most of those who receive treatment regard it as helpful, but receiving helpful treatment typically requires persistence in help-seeking. Future research should focus on ensuring that helpfulness is included as part of the evaluation. Clinicians need to emphasize the importance of persistence to patients beginning treatment. DA - 2021-08-09 DB - OpenUCT DP - University of Cape Town IS - Article number: 392 J1 - BMC Psychiatry KW - Generalized anxiety disorder KW - Pathways to treatment KW - Patient-centered outcomes KW - Treatment helpfulness LK - https://open.uct.ac.za PY - 2021 T1 - Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report TI - Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report UR - http://hdl.handle.net/11427/34194 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12888-021-03363-3
dc.identifier.urihttp://hdl.handle.net/11427/34194
dc.identifier.vancouvercitationStein Dan J, Kazdin Alan E, Ruscio Ayelet M, Chiu Wai T, Sampson Nancy A, Ziobrowski Hannah N, et al. Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report. BMC Psychiatry. 2021;21(Article number: 392) http://hdl.handle.net/11427/34194.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDepartment of Psychiatry and Mental Healthen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceBMC Psychiatryen_US
dc.source.journalissueArticle number: 392en_US
dc.source.journalvolume21en_US
dc.source.urihttps://bmcpsychiatry.biomedcentral.com/
dc.subjectGeneralized anxiety disorderen_US
dc.subjectPathways to treatmenten_US
dc.subjectPatient-centered outcomesen_US
dc.subjectTreatment helpfulnessen_US
dc.titlePerceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys reporten_US
dc.typeJournal Articleen_US
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